Pimple S A, Amin G, Goswami S, Shastri S S
Department of Preventive Oncology, Tata Memorial Hospital, Mumbai, India.
Indian J Cancer. 2010 Jul-Sep;47(3):308-13. doi: 10.4103/0019-509X.64726.
Colposcopic evaluation and guided biopsy is an important diagnostic step and standard of management for abnormal cytology smears in developed countries.
The present study evaluates the performance of colposcopy vs conventional cytology in estimating the presence and grade of cervical disease against the reference standard of histopathology as a secondary test modality to triage women found positive on primary screening by visual inspection with 5% acetic acid (VIA).
Colposcopy and directed biopsy were performed after primary screening for cervical cancer in an urban hospital cancer screening clinic between January 2000 and June 2005, in Mumbai, India.
Healthy women (8863) in the age group of 35-65 years participated in the cervical cancer early detection program in the hospital and community cancer screening clinics in Mumbai. Women found positive on the primary screening test by VIA underwent diagnostic evaluation by Pap smear cytology and colposcopy evaluation with directed biopsies.
Accuracy parameters and their 95% confidence intervals were calculated using 2 X 2 tables and standard formulae.
The test range of sensitivity of colposcopy for the detection of histologically confirmed cervical intraepithelial neoplasia grade 1+ (CIN1+) or CIN2+ was 58.0-74.7% and that of specificity was 57.5-92.9%. The sensitivity and specificity of cytology to detect CIN2+ was 57.4% and 99.4%, respectively.
Colposcopy is a good sensitive test for the detection of CIN and can be considered as a secondary testing tool to triage women found positive on VIA.
在发达国家，阴道镜评估和引导下活检是异常细胞学涂片重要的诊断步骤和管理标准。
本研究以组织病理学作为二级检测方式，评估阴道镜与传统细胞学在估计宫颈疾病的存在和分级方面的表现，以便对通过5%醋酸肉眼检查（VIA）进行初次筛查呈阳性的女性进行分流。
2000年1月至2005年6月期间，在印度孟买一家城市医院的癌症筛查诊所对宫颈癌进行初次筛查后进行阴道镜检查和定向活检。
年龄在35 - 65岁的健康女性（8863名）参与了孟买医院和社区癌症筛查诊所的宫颈癌早期检测项目。通过VIA初次筛查呈阳性的女性接受巴氏涂片细胞学诊断评估和阴道镜检查及定向活检。
使用2×2表格和标准公式计算准确性参数及其95%置信区间。
阴道镜检测组织学确诊的宫颈上皮内瘤变1级及以上（CIN1+）或CIN2+的敏感性测试范围为58.0 - 74.7%，特异性测试范围为57.5 - 92.9%。细胞学检测CIN2+的敏感性和特异性分别为57.4%和99.4%。
阴道镜是检测CIN的良好敏感检测方法，可被视为对VIA检测呈阳性的女性进行分流的二级检测工具。
